Provider Demographics
NPI:1831138767
Name:WALKES, DESMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DESMAR
Middle Name:
Last Name:WALKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-1979
Mailing Address - Country:US
Mailing Address - Phone:512-321-1098
Mailing Address - Fax:512-303-0885
Practice Address - Street 1:815 HIGHWAY 71 W STE 1150
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-0319
Practice Address - Country:US
Practice Address - Phone:512-321-1098
Practice Address - Fax:512-303-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
397700000098481OtherNATIONAL PRACTIONER DATA BANK
TX010063340OtherMEDICARE RAILROAD
TX099560702Medicaid
TXH2887OtherPHYSICIAN'S LICENSE
TX00N62SMedicare PIN
TX010063340OtherMEDICARE RAILROAD
TX099560702Medicaid